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Autogenous Femoral-Femoral Crossover Bypasses: Use in Cases of Infection or Hypercoagulability
Hayley Chang, Benjamin B. Chang, MD, Philip S. Paty, MD, Sean P. Roddy, MD, Kathleen J. Ozsvath, md, Chin-Chin Yeh, MD, John B. Taggert, MD, Yaron Sternbach, MD, Paul B. Kreienberg, MD, Manish Mehta, MD, MPH, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
OBJECTIVES:
Patients presenting with unilateral infected inflow prosthetic reconstruction present a difficult clinical dilemma. One option is an autogenous femoral-femoral crossover bypass. This retrospective study analyzes the indications and effectiveness of autogenous femoral-femoral crossover bypasses.
METHODS:
From 2000 to 2014, 23 patients underwent autogenous femoral-femoral crossover bypasses. These were employed in two general circumstances; first, as a means of leg revascularization in cases where there was an infected prosthetic graft in the recipient groin, and secondly in patients with hypercoagulability in whom previous prosthetic crossover bypass had failed. Follow up involved serial examination and noninvasive studies at six-month intervals. Patients who underwent femoral-femoral bypasses with synthetic grafts were excluded from this study.
RESULTS:
Over a 14 year period, 736 femoral-femoral crossover bypass was performed; 23 were autogenous. In 15 cases, this reconstruction was employed due to infection at the common femoral artery of the recipient limb. The infected previous reconstructions included aortobifemoral bypasses, axillofemoral bypass or iliofemoral bypass. In 8 cases, autogenous bypass was used in cases in which there was unilateral inflow occlusive disease in hypercoagulable patients who had already had failure of a prosthetic crossover bypass. Autogenous greater saphenous vein was employed as conduit in 19 cases. There were no cases of graft infection in the entire group. Graft failure occurred in the early postoperative period in one patient due to poor conduit (spliced arm and short saphenous vein). One failure occurred in a hypercoagulable patient due to thrombosis of the aorta and donor iliofemoral artery. Over a mean follow-up of 39.1 months, patients with this vascular repair had a mean patency of 33.9 months.
CONCLUSIONS:
In selected cases, the use of an autogenous femoral-femoral crossover bypass can be a useful tool in the management of some difficult clinical cases involving groin sepsis or hypercoagulability. The relative resistance of autogenous bypass to infection allows it to be used in cases in which there may be a higher chance for graft contamination. In addition, autogenous bypass may be useful in patients with coagulation disorders and unilateral inflow disease who have had failure of previous prosthetic bypass.
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